INCREASED FREQUENCY OF AUTOAGGRESSION SYNDROME-ASSOCIATED WITH AUTOLOGOUS STEM-CELL TRANSPLANTATION IN BREAST-CANCER PATIENTS

In our BMT Unit, we have observed a high frequency of skin rash associ ated with fever and other clinical findings during engraftment of auto logous BM and/or PBSC. Thirty patients with breast cancer and 12 patie nts with Hodgkin's or non-Hodgkin's lymphoma, treated with the same re gimen, were analyzed retrospectively or prospectively to characterize the clinical syndrome, its frequency, and its clinical course, as well as to define the factors affecting its incidence. In patients develop ing skin rash, the median and range for time to onset of skin rash and for time to increase in WBC after reinfusion of stem cells were ident ical (8 days, range 5-13) and did not differ significantly (P = 0.533) . Twenty-three patients (55%) had skin rash, 18 patients had fever. Ot her, less frequent manifestations include platelet transfusion refract oriness (PTR), diarrhea, diffuse alveolar hemorrhage, and autoimmune t hrombocytopenia or hemolytic anemia. A higher proportion of breast can cer patients developed the syndrome in comparison to lymphoma patients (67% vs 25%, P = 0.051). Acute GVHD grade I-II was established histol ogically in six patients with the syndrome. Comparison of the incidenc e of the syndrome by different variables using Fisher's exact test rev ealed significance for disease category (P = 0.02) and number of previ ous treatment regimens (P = 0.002) as predictive factors for developin g the autoaggression syndrome. In other words, patients with breast ca ncer and those with only one previous treatment regimen were more like ly to develop the syndrome. This study suggests that an autoaggression GVHD-like syndrome accompanies the early phase of autologous engraftm ent and that a higher frequency of the syndrome might be seen in breas t cancer patients undergoing high-dose chemotherapy and autologous ste m cell transplantation.